Objective: To evaluate the therapeutic effectiveness ofBaitouweng decoction enema for ulcerative colitis (UC) and assess its impact on oxidative stress levels. Methods: A total of 85 UC patients were divided into an observation group (n = 43, mesalazine enteric-coated tablets orally +Baitouweng decoction enema) and a control group (n = 42, mesalazine enteric-coated tablets orally) according to different treatment methods. The treatment course was 20 days. The clinical efficacy, Traditional Chinese Medicine (TCM) syndrome score, endoscopic severity index (UCEIS) score, modified Mayo score, Inflammatory Bowel Disease Questionnaire (IBDQ) score, serum oxidative stress indicators [glutathione peroxidase (GSH-Px) and catalase (CAT) activity], serum inflammatory indicators [tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), and interleukin-6 (IL-6) levels], and incidence of adverse reactions were compared between the two groups. Results: The overall efficacy rate in the observation group was higher than that in the control group (93.02% vs. 80.95%, P 0.05). Conclusion:Baitouweng decoction enema reduces symptoms, promotes mucosal healing, and improves quality of life in UC patients with damp-heat syndrome. Its mechanism of action may be associated with enhanced antioxidant enzyme activity and inhibition of the inflammatory response.